What if we could Prevent children from dying of treatable diseases and injuries throughout the worlD?
WE CAN
Texas Children’s Hospital is revolutionizing global pediatric emergency care.
In sub-Saharan Africa, children have a 14 times higher chance of dying by their 5th birthday compared to the continent with the lowest childhood mortality rate. There have been significant improvements to global child survival over the last 20 years through improved access to care and stabilizing the HIV/AIDS epidemic, but kids are now dying of preventable, treatable diseases and injuries at staggeringly high numbers (5.9 million each year or >16,000/day). We know that interventions aimed at early recognition and management of injury and illness can profoundly impact child mortality.
Launched in 2005, the Texas Children’s Hospital / Baylor College of Medicine Global Pediatric Emergency Medicine (PEM) program is strengthening local healthcare infrastructure in partnership with local Ministries of Health and policy advisors. Together, we are building capacity to effectively provide the knowledge and treatments needed to optimally care for emergently ill and injured children across the globe.
Two stories
This fictional story represents the experiences of Dr. Heather Crouse from many years treating children in Malawi and at Texas Children’s Hospital.
Lillian and Emphatso, Houston and Malawi
Lillian was born in Houston, and Emphatso was born in Malawi. Both of their mothers came from educated families, received prenatal care, and gave birth in health centers. Both babies received vaccinations, and Emphatso had bed nets in her home to prevent malaria. Each family did everything they possibly could to ensure their daughters were healthy and happy.
But what happened when they came down with the same illness, characterized by a fever and cough?
In Houston, Lillian’s mother made an appointment with her pediatrician, who recognized that Lillian was working hard to breathe. She was quickly transported by ambulance to the emergency room and admitted to the hospital within hours. She was immediately placed in a room, and a pediatric emergency medicine specialist was called to see her. Because of the level of care she had access to, Lillian’s physicians were able to determine that she had pneumonia. After a few days on medication and oxygen, she was healthy again and was able to return home with her family.
In Malawi, when Emphatso developed a fever and cough, her story developed differently. After two days of worsening symptoms, her family took her to a local health center where she was last in a line of about 50 children. When Emphatso was finally seen, medical providers who unfortunately did not have adequate training did not recognize that she was working hard to breathe.
They also lacked basic medical equipment, so Emphatso’s vital signs were not taken. She was treated with steroids—a common response to this type of illness—and was sent home.
Two days later, when Emphatso was still struggling to breathe, her worried family raised money in her village to pay for transport to a district hospital. The trip took hours and after arriving, she was once again in a very long line of children who were waiting to be seen. Even at the district hospital, there was no equipment to test her vital signs, and because of limited space, Emphatso had to share a bed with three other patients. The physicians and nurses there were also undertrained and had so many patients that many hours passed before they were able to see her. They did not diagnose Emphatso’s pneumonia—and even if they had, there were no antibiotics or oxygen tanks for them to use for treatment. Soon, Emphatso simply stopped breathing.
The only difference between Lillian and Emphatso was where they live. The same illness that Lillian quickly overcame because of the heath care provided to her in the United States is just one of the many treatable illnesses that ends the lives of thousands of children in sub-Saharan Africa.
This is not how it has to be. Texas Children’s can continue to change the world’s pediatric health care disparities. We can continue to save lives here in Houston and around the world. But we can’t do it without help from people like you.
Give to global Pediatric emergency medicine
Thank you for supporting the Global Pediatric Emergency Medicine program at Texas Children's Hospital. Your gift helps us provide life-saving care and develop training programs to treat children at the most critical moments of hospital care throughout the world.
Our Vision
Texas Children’s Hospital’s vision is to optimize health outcomes for vulnerable injured and acutely ill children globally.
Work is already underway in the United States, Belize, Guatemala, El Salvador, Nicaragua, Panama, Colombia, Botswana and Malawi. To date, Global PEM has had dramatic success providing over 25,000 hours of clinical care and shoulder-to-shoulder mentoring for emergently ill children alongside our global partners and training over 5,000 health professionals in 23 countries.
Our Mission
Through ethical and committed bidirectional partnerships, improve the care of vulnerable injured and acutely ill children globally by collaboratively developing and implementing high quality, sustainable initiatives that are based on local priorities and resources for clinical care, education, advocacy and scholarship.
THE CHALLENGE
Most healthcare centers in low and middle-income country (LMIC) settings lack essential pediatric-focused staffing, infrastructure and supplies. What’s more, evidence suggests that inadequate initial patient assessment and delays in delivering life-saving treatment contributes to poor outcomes for young patients.
Interventions, such as clinical training to increase the pediatric workforce, education, process improvement and research, help improve pediatric emergency care and lead directly to reductions in child mortality. Within the field of pediatric global health, pediatric emergency medicine stands uniquely poised as the bridge between prevention and definitive care (from primary to tertiary) and helps close the gap of existing health disparities found in child healthcare around the world.
Each year, over 5.9 million children worldwide die of preventable, treatable injuries and illnesses, most without ever receiving proper diagnosis or any treatment.
In sub-Saharan Africa and Latin America, these deaths occur primarily because they don’t have access to modern medical resources and a fully trained cadre of pediatric specialists.
Unique Approach
Global PEM offers a unique approach to improving pediatric mortality globally.
We partner with healthcare institutions and governments to meet them where they are to enhance and develop the care provided locally. We can augment capacity and improve services working anywhere—on an ambulance or in other pre-hospital care settings, in a health center or hospital, or during a disaster. We can go wherever we are needed. We focus on low-cost, high-impact initiatives both within the U.S. and globally.
With over 15 years of experience working in a variety of LMICs, endorsements by Latin American and African healthcare leaders, and in collaboration with the Pan American Health Organization (PAHO) and local Ministries of Health, Global PEM is implementing the following:
training & education
Building self-sustaining capacity by training local LMIC doctors, nurses, and other healthcare professionals through train-the-trainer programs, both in-person and virtually.
Care & Treatment
Providing direct clinical care and shoulder-to-shoulder mentoring for acutely ill and injured children globally.
health system strengthening
Strengthening healthcare infrastructure by partnering with institutions and Ministries of Health to improve healthcare staffing, process implementation and access to life-saving medications, equipment and supplies, along the continuum of pediatric care.
INNOVATION & development
Building new technology for improving access to high-quality pediatric emergency care.
ADVOCAcY
Increasing awareness of child health disparities globally.
RESEARCH
Disseminating collaborative scholarship with our global partners that shares best practices in pediatric emergency care for those working in similar settings.
Where we work
MALAWI
The Republic of Malawi ranks among the world’s most densely populated and underdeveloped countries with 67% of the country’s nearly 19 million people under the age of 24. Kamuzu Central Hospital (KCH) is the national referral hospital in the capital city of Lilongwe serving the central region of Malawi. The pediatric ward admits more than 27,000 patients per year and manages all medical emergencies with very few Malawian pediatric healthcare workers.
Pachimake means “at the heart of the matter” in Chichewa, a Bantu language spoken in parts of Malawi—and Texas Children’s in partnership with Baylor College of Medicine Children’s Foundation-Malawi intends to get at the heart of the matter to address pediatric emergency care challenges at KCH. A recently established initiative bringing together KCH and the Malawi College of Medicine with 4 U.S.-based pediatric hospitals (BCM Children’s Foundation and Center of Excellence Malawi, Texas Children’s Hospital / Baylor College of Medicine, Cincinnati Children’s Hospital Medical Center, University of North Carolina Chapel Hill / Project Malawi, University of Utah / Primary Children’s Hospital) — the Pediatric Alliance for Child Health Improvement in Malawi at KCH and Environs (PACHIMAKE)—aims to improve the care of acutely ill children through implementation of high quality and sustainable clinical, educational, and research initiatives and partnership. Goals focus on improving access to high quality emergency care, building capacity for pediatric providers to care for acutely ill children at KCH, strengthening partnerships and improving infrastructure including development of care processes, improvement of facilities and ensuring access to medication, equipment, and supplies. We anticipate this consortium can serve as a model of collaboration for institutions striving to improve pediatric healthcare systems in other Low- and Middle-Income Countries (LMICs).
LATIN AMERICA
The Emergency Triage Assessment and Treatment (ETAT) guidelines and training program were developed by the World Health Organization (WHO) as part of the Integrated Management of Childhood Illnesses (IMCI) strategy to promote improved assessment, triage, and initial management / stabilization of acutely ill children in resource-limited hospital-based settings, which has been shown to decrease pediatric mortality. Global PEM faculty members developed locally-relevant supplemental ETAT train-the-trainer curricula in English and Spanish and have implemented high-quality, sustainable training programs and triage processes for pediatric healthcare workers in Africa and throughout Latin America including Guatemala, El Salvador, Nicaragua, Panama and Belize, in collaboration with PAHO and local Ministries of Health. Successes to date: Program rollout to 7 countries; integration of the curriculum into the national norms of 2 countries; training of 135 facilitators who have subsequently trained over 1200 participants in their respective countries; evaluated and collaboratively published results of both the training program and triage process implementation.
BELIZE
Belize is a middle-income country of 375,000 inhabitants bridging both the Caribbean and Central America. Due to its size, it does not have a medical school or residency programs, and most providers are general practitioners that lack formal emergency medicine knowledge or skill sets. The healthcare capacity of the nation has not kept up with its growing local and tourist populations, with 0.7 physicians per 1,000 inhabitants and 39.7 healthcare providers per 1,000 inhabitants. Increasing and strengthening healthcare capacity is a strategic priority for the country and its regional partners, as noted in the World Health Organization’s (WHO) 2017 Country Cooperation Strategic Agenda Strategic Priority 2 for Belize. Despite its size, Belize has a high burden of emergency service use. The main and only government-funded tertiary referral center in the country, Karl Heusner Memorial Hospital Authority (KHMHA), sees ~25,000 patients annually in the ED. Twenty-two percent (22%) of these are trauma cases, with a significant mortality rate of 19%. There is a need and a desire to improve emergency service care that is provided nationwide.
Since 2015 Global PEM has partnered with Baylor College of Medicine Department of Emergency Medicine, the Belizean Ministry of Health and KHMHA to train local healthcare providers in pediatric emergency care. 884 healthcare providers have been trained in locally-relevant PEM topics, ETAT, Point-Of-Care-Ultrasound (POCUS) and the WHO’s Basic Emergency Care course. These educational trainings have utilized train-the-trainer approaches and have been linked with process improvement in setting which take care of emergently ill and injured children.
UNITED STATES
An important part of our work starts at home. The Baylor Pediatric Emergency Medicine - Global Health (PEM-GH) Fellowship was established in 2005 in response to growing interest in global health among trainees. As the first pediatric global health fellowship in the U.S., our combined program is the largest in the country and is recognized as a model of excellence. Since 2005, 16 fellows have enrolled in the combined PEM-GH fellowship, 11 have graduated from the program and an additional 8 standard track PEM fellows have participated in components of the global health track.
These 24 PEM-GH fellows have received 18 grants/scholarships, presented 59 platform/poster conference presentations, and published 28 manuscripts. Nearly all of our graduates pursue academic careers, and many are leading global health programs around the country. Our fellows have provided care to emergently ill and injured children in 23 countries with an increasing focus on sustainability and integration with existing global health programs. They are the future leaders in global PEM.
LEADERSHIP
Joan Shook, MD, MBA
Interim Chief of Service, Pediatric Emergency Medicine, Texas Children’s Hospital
Associate Professor of Pediatrics, Emergency Medicine, Baylor College of Medicine
Heather Crouse, MD
Director of Global Pediatric Emergency Medicine Program and PACHIMAKE Consortium Lead, Texas Children’s Hospital
Associate Professor of Pediatrics, Emergency Medicine, Baylor College of Medicine
Marideth Rus, MD, M.Ed.
Director of Pediatric Emergency Medicine – Global Health Fellowship, Texas Children’s Hospital
Assistant Professor of Pediatrics, Emergency Medicine, Baylor College of Medicine
Team
Andrea T. Cruz, MD, MPH
Director of Tuberculosis Clinic and Research Chief, Emergency Medicine, Texas Children’s Hospital
Associate Professor of Pediatrics, Emergency Medicine, Baylor College of Medicine
Nichole Davis, MD, MEd
Associate Director of Emergency Management, Emergency Medicine, Texas Children’s Hospital
Assistant Professor of Pediatrics, Emergency Medicine, Baylor College of Medicine
Liliana Morales-Perez, MD, MPH
Faculty, Global Point-of-Care-Ultrasound (POCUS) Program
Assistant Professor of Pediatrics, Emergency Medicine, Baylor College of Medicine
Binita Patel, MD
Chief of Clinical Operations, Pediatric Emergency Medicine and Chief Medical Quality Officer, Texas Children’s Hospital
Associate Professor of Pediatrics, Emergency Medicine, Baylor College of Medicine
Eric Russell, MD
Executive Committee Member, Program for Immigrant and Refugee Child Health (PIRCH), Texas Children’s Hospital
Assistant Professor of Pediatrics, Emergency Medicine, Baylor College of Medicine
Manish Shah, MD, MS
Chief of Academic Development and Strategy, Emergency Medicine
Associate Professor of Pediatrics, Emergency Medicine, Baylor College of Medicine
Pediatric Emergency Medicine - Global Health Fellows
Justin Moher, MD – 4th Year
Claire Gahm, MD – 3rd Year
Ted Tanner, MD, MPH – 2nd Year
Kimberley Farr, MD – 2nd Year
Aya Fanny, MD, MPH – 1st Year
Shubhada Hooli, MD, MPH – 1st Year
PARTNERS
Texas Children’s Hospital partners with numerous institutions to ensure the highest quality of care and training for our Global PEM Program. These partners include:
Baylor College of Medicine
Kamuzu Central Hospital Department of Paediatrics
University of Malawi College of Medicine
Baylor College of Medicine Children’s Foundation-Malawi
Cincinnati Children’s Hospital Medical Center
University of North Carolina - Project Malawi
University of Utah Primary Children’s Hospital